Arthroplasty skills need to be acquired safely during training, yet operative experience is increasingly hard to acquire by trainees. Virtual reality (VR) training using headsets and motion-tracked controllers can simulate complex open procedures in a fully immersive operating theatre. The present study aimed to determine if trainees trained using VR perform better than those using conventional preparation for performing total hip arthroplasty (THA). A total of 24 surgical trainees (seven female, 17 male; mean age 29 years (28 to 31)) volunteered to participate in this observer-blinded 1:1 randomized controlled trial. They had no prior experience of anterior approach THA. Of these 24 trainees, 12 completed a six-week VR training programme in a simulation laboratory, while the other 12 received only conventional preparatory materials for learning THA. All trainees then performed a cadaveric THA, assessed independently by two hip surgeons. The primary outcome was technical and non-technical surgical performance measured by a THA-specific procedure-based assessment (PBA). Secondary outcomes were step completion measured by a task-specific checklist, error in acetabular component orientation, and procedure duration.Aims
Patients and Methods
Recently, there has been considerable interest in quantifying
the associations between bony abnormalities around and in the hip
joint and osteoarthritis (OA). Our aim was to investigate the relationships
between acetabular undercoverage, acetabular overcoverage, and femoroacetabular
impingement (FAI) with OA of the hip, which currently remain controversial. A total of 545 cadaveric skeletons (1090 hips) from the Hamann-Todd
osteological collection were obtained. Femoral head volume (FHV),
acetabular volume (AV), the FHV/AV ratio, acetabular version, alpha
angle and anterior femoral neck offset (AFNO) were measured. A validated
grading system was used to quantify OA of the hip as minimal, moderate,
or severe. Multiple linear and multinomial logistic regression were
used to determine the factors that correlated independently with
the FHV, AV, and the FHV/AV ratio. Aims
Materials and Methods
We aimed to quantify the relative contributions of the medial
femoral circumflex artery (MFCA) and lateral femoral circumflex
artery (LFCA) to the arterial supply of the head and neck of the
femur. We acquired ten cadaveric pelvises. In each of these, one hip
was randomly assigned as experimental and the other as a matched
control. The MFCA and LFCA were cannulated bilaterally. The hips
were designated LFCA-experimental or MFCA-experimental and underwent
quantitative MRI using a 2 mm slice thickness before and after injection
of MRI-contrast diluted 3:1 with saline (15 ml Gd-DTPA) into either
the LFCA or MFCA. The contralateral control hips had 15 ml of contrast
solution injected into the root of each artery. Next, the MFCA and
LFCA were injected with a mixture of polyurethane and barium sulfate
(33%) and their extra-and intra-arterial course identified by CT
imaging and dissection.Aims
Materials and Methods
The acetabular labrum is a soft-tissue structure
which lines the acetabular rim of the hip joint. Its role in hip
joint biomechanics and joint health has been of particular interest
over the past decade. In normal hip joint biomechanics, the labrum
is crucial in retaining a layer of pressurised intra-articular fluid
for joint lubrication and load support/distribution. Its seal around
the femoral head is further regarded as a contributing to hip stability through
its suction effect. The labrum itself is also important in increasing
contact area thereby reducing contact stress. Given the labrum’s
role in normal hip joint biomechanics, surgical techniques for managing
labral damage are continuously evolving as our understanding of
its anatomy and function continue to progress. The current paper
aims to review the anatomy and biomechanical function of the labrum
and how they are affected by differing surgical techniques. Take home message: The acetabular labrum plays a critical role
in hip function and maintaining and restoring its function during
surgical intervention remain an essential goal. Cite this article:
We investigated the detailed anatomy of the gluteus
maximus, gluteus medius and gluteus minimus and their neurovascular
supply in 22 hips in 11 embalmed adult Caucasian human cadavers.
This led to the development of a surgical technique for an extended
posterior approach to the hip and pelvis that exposes the supra-acetabular
ilium and preserves the glutei during revision hip surgery. Proximal
to distal mobilisation of the gluteus medius from the posterior
gluteal line permits exposure and mobilisation of the superior gluteal
neurovascular bundle between the sciatic notch and the entrance
to the gluteus medius, enabling a wider exposure of the supra-acetabular
ilium. This technique was subsequently used in nine patients undergoing
revision total hip replacement involving the reconstruction of nine
Paprosky 3B acetabular defects, five of which had pelvic discontinuity.
Intra-operative electromyography showed that the innervation of
the gluteal muscles was not affected by surgery. Clinical follow-up
demonstrated good hip abduction function in all patients. These
results were compared with those of a matched cohort treated through
a Kocher–Langenbeck approach. Our modified approach maximises the
exposure of the ilium above the sciatic notch while protecting the
gluteal muscles and their neurovascular bundle. Cite this article: Bone Joint J 2014;96-B:48–53.
